Menopause, Depression and Mood Disorders

The transition to menopause or perimenopause represents the passage from reproductive to non-reproductive life. Most women during the perimenopause experience irregular menstrual periods (e.g., shortened or longer cycles), physical and emotional changes. The menopausal transition usually begins during a woman’s 40s, with a mean age of 47.5 years, and an average duration of 4-8 years. The menopause is defined by the occurrence of the last menstrual period followed by 12 months without menses. The menopause usually occurs at a mean age of 51 years.

Symptoms of the Menopausal Transition

Menopause is marked by changes in the menstrual frequency, length and menstrual flow. Very classical are the presence of vasomotor symptoms such as hot flushes and night sweats (hot flushes that occur with sweating causing nocturnal awakenings). A hot flush is a “transient episode of flushing, sweating and a sensation of heat, often accompanied by palpitations and a feeling of anxiety, and sometimes followed by chills”, and is experienced by 45-85% of women. In natural menopause these vasomotor symptoms usually diminished over the following two years.

Women who underwent surgical menopause, on the other hand, commonly experience more severe vasomotor symptoms right after surgery. Other physical changes/symptoms commonly observed during the menopausal transition include insomnia, memory problems, sexual dysfunction, and higher risk for osteoporosis or cardiovascular disease.

Depression and the Menopause

The lifetime prevelance of depression in women is between 15 to 25 %. Some studies found increased risk of recurrence of depression in women during menopause specially in women with prior history of depression, history of PMDD, history of post partal depression, loss of significant others, caretaking responsibilities with lack of social support difficult relation with partner and chronic health problems.

Causes of depression in Menopause

Severe hormone changes affect mood and behavior by altering the equilibrium in several neurotransmitter systems in the brain. This would explain the occurrence of higher rates of depression during the perimenopause (when hormonal changes are intense, sometimes chaotic), compared to postmenopausal years – when estrogen levels are low, but stable.

From a more psychosocial point of view, the menopausal transition has been traditionally identified as a non-adaptative event, during which women are at risk of losing a “major role”: maternity. Thus, the “empty-nest syndrome” (when children leave home) was proposed as a psychosocial cause of psychological symptoms manifesting during the menopausal transition. The relative validity of this theory has been questioned, and appears to be restricted to women who are too engaged and over-involved with their children, and would consequently feel useless, isolated and depressed when the children leave home.

Treatment for Menopause Depression and Related Symptoms

The use of hormone replacement therapy (HRT) has been the treatment of choice to alleviate physical symptoms associated with the menopausal transition (short-term use of HRT), and to help in preventing the clinical consequences of an estrogen-deficient state, including osteoporosis and cardiovascular disease (long-term use of HRT).

Recent results form large, prospective studies (e.g., HERS, WHI), however, have questioned the safety of long-term use of HRT, as well as its efficacy to prevent cardiovascular diseases. Because of that, many women have decided to discontinue their HRT regimens.

Lastly, recent studies suggest that antidepressants promote improvement of vasomotor symptoms; they may constitute an interesting alternative for those who are unable or unwilling to take HRT for the alleviation of menopause-related depressive symptoms and vasomotor complaints.